www.pspbc.ca advanced access & office efficiency learning session 1 fall, 2010
TRANSCRIPT
www.pspbc.ca
Advanced Access & Office Efficiency
Learning Session 1
Fall, 2010
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At the end of today’s session, participants will:
› be able to describe advanced access and how it can benefit their practice
› understand a process for trying small changes to improve access in their practice
› have a plan for trying some small changes over the next couple of months
Welcome
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GPSC
› who, what, why
Practice Support Program (PSP)
› Who, what, why
› Reimbursement
› Accreditation – Main Pro C, Main Pro M1
GPSC and PSP
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All systems work best when they work without a delay Delays exist in family practices when patients are
waiting for an appointment and while waiting at an appointment
Reducing these delays has benefits of:
› Clinical outcomes for patients
› Satisfaction of patients, physicians and staff
› Costs
› Revenue
› Patient/provider relationship
Introduction
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The care of patients will be redesigned to improve access,
capacity and efficiency.
How will the aim be accomplished? Advanced Access, and Office Efficiency change packages will be
useto decrease the wait time of patients for, and at, appointments
inPrimary Care
How will we know this has been accomplished? Change will be evidenced by improved 3rd next available
appointment,and improved appointment cycle time.
Collaborative Aim
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Collaborative Measures
Delay for appointment
Cycle times
Patient experience – Access
Patient experience – Office Efficiency
Provider and staff experience
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Physician:
“I can do all of today’s work today.”
Patients:
“I get the care I need when I need it.”
Advanced Access
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Seeing your own patients when they need and want to be seen
Eliminating delays for an appointment Evidence-based
What is Advanced Access?
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Ensuring you see more patients Carving out time in your already full schedule Asking patient to call back the next day to schedule an
appointment on “same day” A government plot to make physicians work harder!
What Advanced Access is not!
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My experience – Dr. ______________
Before advanced access: Patient care Physician quality of life MOA quality of life Financial e.g. walk-in losses Delay No shows Patient dissatisfaction
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After advanced access: Improved patient care:
“I can do all of today’s work today”
› Reduction in delay for appointments Improved physician quality of life
› Leave on time
› Efficient appointments
› Fewer patient “lists” Improved MOA quality of work life
› Less time on the phone
› Less negotiating with patient Financial
My experience
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Key concepts of Advanced Access
Understand, measure and balance your supply and demand
Work down your backlog Reduce your scheduling complexity Develop contingency plans
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1. Understanding Supply and Demand
panel: creates real work
Waiting: work waiting to be addressed (backlog) Delays
If S < D: reservoir fills, backlog builds up, delays
Waiting
reservoir
Demand (patient panel)
Supply (Number of appointments available)
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Requests for appointments
External – patient driven
Internal – practice driven
What is demand?
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The number of appointment slots available in a given day
Supply is what you have in your schedule to meet your demand.
What is supply?
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Reduce demand
Increase supply
Supply:Demand
Demand
Supply
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Delay Demand Supply Panel size
› Physician profile report
› Billing
Measures
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To measure the delay for appointments and to correct for cancellations we use the third next available
appointment
Next available appt: (could be cancellation) 2nd next available appt : (could be cancellation) 3rd next available appt: (measure of access)
Measure the number of days to the 3rd next?
Measuring delays
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Record every request for an appointment Include appointment requests from all sources Count demand on the day the request comes in
regardless of when the appointment date is scheduled Track demand daily
Measuring demand
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Tool to measure demand
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Choose a typical week in the future. Avoid weeks before, during and immediately after holidays
Count every available appointment slot each day and record it
If there are predefined double slots, count them as two If there is more than one physician, count for each of
them separately
Measuring supply
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Schedules
100% booked
“Do yesterdays work today.”
Traditional model Example of an Advanced access model
“Do today’s work today.”
65% open 35% booked
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What is meant by “Backlog”? The total work that is waiting for you between today and
the third next available appointment
Types of backlog: Good backlog:
› Appropriate follow up
› Planned future visits Bad back log:
› Today’s work pushed to the future – appointments requested for today that could not be accommodated today
› Scheduled appointments that may be unnecessary
2. Reducing the Backlog (the reservoir)
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Calculating backlog
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Review the measurement tools Review your schedule Assess backlog
Activity
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Review schedule & push ahead some good backlog Review schedule & deal with any appointments via
phone or email, if possible Temporarily increase hours
› Schedule a couple of extra appointment slots/day
› Add another day or half-day if not working full time
Strategies for Reducing Backlog
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Review call back standards or policies
› Prescription renewal
› Chronic disease/multiple follow-ups Bring in locum or share/overlap with other physicians or
practices
Reducing the Backlog
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Reduce appointment types Use “truth in scheduling” Review and revise
scheduling “rules”
3. Reducing scheduling complexity
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4. Contingency Planning
Planning for time out of office anticipated or unanticipated
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“Freeze/Unfreeze Strategy”
Before holiday begins:– freeze all appointment slots for physician’s 1st week back
(1st week back)
…/
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Freeze/Unfreeze Strategy
…/
(1st week back)
MOA will continue to unfreeze mornings on a day-by-day basis …
On Monday of the last week of holiday, open the schedule for the Monday morning of the 1st week back
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Freeze/Unfreeze Strategy
(1st week back)
MOA will continue to unfreeze afternoons on a day-by-day basis …
On the Monday of the 1st week back, open the afternoon appointments for that same Monday
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Break
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An evidence based approach to making sustainable changes
Involves finding the answers to the following questions:
› What are we trying to accomplish (Aims)?
› How do we know change is an improvement (Measures)?
› What changes can we make that will result in an improvement (Tests of change)?
The Model for Improvement
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What are we trying toaccomplish?
How will we know that achange is an improvement?
What changes can we make thatwill result in improvement?
Model for Improvement
Act Plan
Study Do
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Measures TargetCurrent
(Baseline)
Practice Aim
Delay for appointmentAble to offer same day, if requested
Cycle times[practice &
context specific]
__ minutes% improvement
Patient experience – Office Efficiency (1)
80% answer“most of the
time”%
Patient experience – Access (2)
80% answer “Very easy”
%
Provider and staff experience (3)
80% answer “most of the
time”%
“When you visit your doctor’s office, how often is it well organized, efficient, and does not waste your time?”“How easy is it for you to see your family physician when you need to?”“I start and end my day on time.”
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Try a few small tests of change…
Aim: To reduce the number of appt. types to short and long
Reduction of types down to long and short?
A PS D
D SP A
DATAD SP A
Cycle 1: Pick one morning in the next week to appoint patients into short or long appointment types. Did the appointments start and end on time?
Cycle 2: Choose a week in the future to book appointments according to short and long time slots. Was it easy to book this way?
Cycle3: Pick a future day in the schedule just beyond the 3rd next available, and start booking by short and long time slots.
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Where do I start?
What are you going to do next Tuesday?
What is your aim? Determine how you will
measure/track improvement
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What do you tell patients about your changes? How will you get the message across? (brochures,
posters, etc) Use of the MOA “script”
Patient considerations
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Timeframe RST Support Data/measures
Action Period
Good Luck!